The management of tricuspid valve disease associated with mitral or mitral-aortic disease continues to be a controversial subject. In 1967 the argument for conservative management was presented by this Clinic. Since that time, our approach to tricuspid valve disease has become more aggressive and an increasing number of patients undergo tricuspid valve replacement or annuloplasty. A retrospective review was undertaken to compare the results of conservative management vs. tricuspid annuloplasty vs. tricuspid valve replacement. During the years 1972-74 patients were diagnosed to have tricuspid regurgitation and/or stenosis by palpation of the valve at the time of operation. Twenty-one patients did not undergo any tricuspid procedure, 30 patients underwent tricuspid annuloplasty, 25 underwent tricuspid valve replacement with porcine xenografts. A good clinical result was achieved in significantly more patients undergoing tricuspid valve replacement (80%) than in patients undergoing tricuspid valve disease. Tricuspid valve replacement is shown to be superior to tricuspid annuloplasty.